ANATOMY OF THE UPPER LIMB DR.AHMAD K. SHAHWAN PH.D. GENERAL SURGERY DR.AHMAD K. SHAHWAN PH.D. GENERAL SURGERY

ANATOMY OF THE ANATOMY OF THE UPPER LIMBUPPER LIMB


DR.AHMAD K. SHAHWAN DR.AHMAD K. SHAHWAN

PH.D. GENERAL SURGERYPH.D. GENERAL SURGERY

DR.AHMAD K. SHAHWAN DR.AHMAD K. SHAHWAN

PH.D. GENERAL SURGERYPH.D. GENERAL SURGERY


11 - -Bones of the upper limbBones of the upper limb..

22 - -Muscles of the upper limbMuscles of the upper limb..

33 - -Vesseles of the upper limbVesseles of the upper limb..

44 - -Nerves of the upper limbNerves of the upper limb..

55 - -Joints of the upper limbJoints of the upper limb..

ANATOMY OF THE ANATOMY OF THE UPPER LIMBUPPER LIMBSurface anatomy of the upper Surface anatomy of the upper limblimb..

The upper limb divided toThe upper limb divided to

11 - -The ShoulderThe Shoulder

22 - -The armThe arm

33 - -The forearmThe forearm

44 - -The handThe hand

55 - -The axilla & the breastThe axilla & the breast

ANATOMY OF THE UPPER ANATOMY OF THE UPPER LIMBLIMB

THE SHOULDERTHE SHOULDER

IT CONTAINS IT CONTAINS THE THE SCAPULASCAPULA&& THETHE CLAVICLECLAVICLE which which articulate with the sternum articulate with the sternum & the humerus& the humerus..

THE THE SCAPULASCAPULA

**It is a flat bone with It is a flat bone with 2 2 surfacessurfaces (ventral& (ventral& dorsal).&3 dorsal).&3 anglesangles (superior, lateral& (superior, lateral& inferior).& 3 inferior).& 3 borders borders (medial ,lateral & (medial ,lateral & superior)superior)..

**It has a It has a spine ,acromial spine ,acromial process process &coracoid process&coracoid process..

THE SCAPULATHE SCAPULA

The ventral (costal) surfaceThe ventral (costal) surface is is concave &forms the subscapular concave &forms the subscapular fossafossa..

The dorsal surfaceThe dorsal surface is convex is convex &divided by the spine of the &divided by the spine of the scapula to 2 fossaescapula to 2 fossae::

11 - -a small a small supraspinous fossasupraspinous fossa..

22--a large a large infraspinous fossainfraspinous fossa..

THE SCAPULATHE SCAPULAThe The spinespine of the scapula starts of the scapula starts medially to extend laterally medially to extend laterally where be wider to form where be wider to form acromial acromial processprocess which articulate with the which articulate with the lateral end of the clavicle lateral end of the clavicle..At the lateral end of the superior At the lateral end of the superior border is the border is the coracoid processcoracoid process..The superior angleThe superior angle lies opposite lies opposite the second rib while the second rib while the inferior the inferior angleangle lies opposite the seventh lies opposite the seventh rib.rib. The lateral angle The lateral angle forms the forms the glenoidglenoid cavitycavity..

Articulation of the scapulaArticulation of the scapula

There are 2 synovial & 2 fibrous jointsThere are 2 synovial & 2 fibrous joints..11--The synovial jointsThe synovial joints: :

1-11-1--The glenoid cavity with the head of The glenoid cavity with the head of the humerus to form the humerus to form the shoulder the shoulder jointjoint. .

1-21-2--Acromio-clavicular jointAcromio-clavicular joint22 - -The fibrous jointsThe fibrous joints: :

2-12-1 - -coraco- clavicular joint (strong coraco- clavicular joint (strong joint covered with strong ligament)joint covered with strong ligament)

2-22-2 - -coraco- acromial joint (strong joint coraco- acromial joint (strong joint covered with strong ligament)covered with strong ligament)

Anastamosis around the Anastamosis around the scapulascapula

It is an important anastamosis between It is an important anastamosis between branches of the first part of the branches of the first part of the subclavian A.& the third part of axillary Asubclavian A.& the third part of axillary A..

11 - -branches of the first part of the branches of the first part of the subclavian Asubclavian A

1-11-1 - -the supra scapularthe supra scapular AA. which distributed . which distributed to the supraspinous & the infraspinous to the supraspinous & the infraspinous fossafossa..

1-21-2 - -deep branch of the transverse cervical deep branch of the transverse cervical AA. which go down along the medial . which go down along the medial border of the scapulaborder of the scapula..


22 - -The branches of the third part of The branches of the third part of axillary Aaxillary A..

2-12-1 - -the sub scapular Athe sub scapular A. which go down . which go down along the lateral border of the scapulaalong the lateral border of the scapula..

2-22-2 - -the circumflex scapularthe circumflex scapular AA. which arise . which arise from the sub scapular A.& go to the from the sub scapular A.& go to the infraspinous fossainfraspinous fossa..

THE CLAVICLETHE CLAVICLEIt lies horizontally in the root of the neck. It It lies horizontally in the root of the neck. It covers the flat 1covers the flat 1stst rib& its medial 2/3 are rib& its medial 2/3 are curved forward to give room for the passage curved forward to give room for the passage of the large vessels & nerves which leave the of the large vessels & nerves which leave the neck & pass behind & below the clavicle on neck & pass behind & below the clavicle on their way to upper limbtheir way to upper limb..

It has 2 important functionsIt has 2 important functions::

11-- To transmit forces from the upper limb to the To transmit forces from the upper limb to the bones of the axial skeleton (sternum) bones of the axial skeleton (sternum)

22-- To act as strut holding the arm free from the To act as strut holding the arm free from the trunk trunk . .

THE CLAVICLETHE CLAVICLE

It is along bone with a body & 2 endsIt is along bone with a body & 2 ends::

11-- the sternal endthe sternal end articulate with the articulate with the manuberium of the sternum forming manuberium of the sternum forming the sternoclavicular jointthe sternoclavicular joint..

22--The acromial endThe acromial end articulate with the articulate with the acromial process of the scapula acromial process of the scapula forming the acromio- clavicular jointforming the acromio- clavicular joint..

The body is convex in medial 2/3 The body is convex in medial 2/3 concave in lateral 1/3concave in lateral 1/3..

THE CLAVICLETHE CLAVICLEImportant relations of the clavicleImportant relations of the clavicle

11--The subclavian A.&V.&the trunk of the The subclavian A.&V.&the trunk of the brachial pluxes pass behind the brachial pluxes pass behind the middle 1/3 of the claviclemiddle 1/3 of the clavicle..

22-- The common carotid A. lies behind the The common carotid A. lies behind the left sternoclavicular jointleft sternoclavicular joint . .

33-- the brachio-cephalic A. divided to its 2 the brachio-cephalic A. divided to its 2 branches behind the right branches behind the right sternoclavicular jointsternoclavicular joint..

44--The internal jugular vein lies a little The internal jugular vein lies a little laterally on either sidelaterally on either side..

THE HUMERUSTHE HUMERUS

It is a tubular long bone composed of It is a tubular long bone composed of upper end , body (shaft ) & lower endupper end , body (shaft ) & lower end..

The upper end formed fromThe upper end formed from

11 - -thethe head head

22 - -thethe neck neck ( anatomical &surgical )( anatomical &surgical )

33 - -the the tuberclestubercles (greater & lesser ) (greater & lesser )

..

THE HUMERUSTHE HUMERUS

The headThe head : which is less than ½ sphere directed : which is less than ½ sphere directed medially ,upward &posteriorly .It is separated medially ,upward &posteriorly .It is separated from the greater & lesser tuberosities by a from the greater & lesser tuberosities by a shallow groove called the shallow groove called the anatomical neckanatomical neck. .

The greater tuberosityThe greater tuberosity is a prominence which is a prominence which projects posteriorly in rest positionprojects posteriorly in rest position..

The lesser tuberosityThe lesser tuberosity is a small prominence is a small prominence which project anteriorlywhich project anteriorly..

The greater & lesser tuberosities & the head The greater & lesser tuberosities & the head are separated from the shaft by the are separated from the shaft by the surgical surgical neckneck..

There is small groove below them called the There is small groove below them called the bicipital groovebicipital groove. .

THE HUMERUSTHE HUMERUSThe body (shaft ): The body (shaft ): the upper ½ of the the upper ½ of the shaft is cylindrical while the lower ½ shaft is cylindrical while the lower ½ is like a prismis like a prism..

The lateral & medial borders of the The lateral & medial borders of the lower shaft are continued below to lower shaft are continued below to form the form the lateral & medial lateral & medial supracondyler ridges (crests)supracondyler ridges (crests) which which end with the end with the lateral & mediallateral & medial epicondylesepicondyles..

In the middle of the shaft there is In the middle of the shaft there is deltoiddeltoid tuberosity & the spiral groovetuberosity & the spiral groove ..

THE HUMERUSTHE HUMERUSThe lower end formed from( from medial The lower end formed from( from medial

to lateral )to lateral ) : : 11 - -the anterior aspectthe anterior aspect :medial epicondyle , :medial epicondyle ,

trochlea ,capitulum & lateral epicondyle trochlea ,capitulum & lateral epicondyle . With 2 fossae (coronoid & radial ). With 2 fossae (coronoid & radial ). .

22 - -the posterior aspectthe posterior aspect: medial epicondyle : medial epicondyle , trochlea & lateral epicondyle with one , trochlea & lateral epicondyle with one fossa (olecranon)fossa (olecranon). .

The medial epicondyle is larger , more The medial epicondyle is larger , more prominent & extend downward more prominent & extend downward more than the lateral .It carries a shallow than the lateral .It carries a shallow groove in the posterior surface for the groove in the posterior surface for the ulner nerveulner nerve. .

3 Snell\Upper limb\473.jpg

THE HUMERUSTHE HUMERUSLigaments attached to the humerusLigaments attached to the humerus: :

11-- The capsule of the shoulder joint is The capsule of the shoulder joint is attached to the anatomical neck attached to the anatomical neck except inferiorly where it extends except inferiorly where it extends for about 1 cm. to attach to the for about 1 cm. to attach to the surgical necksurgical neck..

22-- The capsule of the elbow joint where The capsule of the elbow joint where attached to the upper margins of attached to the upper margins of the fossaethe fossae

33-- The lateral & medial supracondyler The lateral & medial supracondyler ridges give attachments to the ridges give attachments to the lateral & medial intermuscular lateral & medial intermuscular septumseptum. .

THE HUMERUSTHE HUMERUSNerves related to the humerusNerves related to the humerus: :

11-- The circumflex (axillary) N. may The circumflex (axillary) N. may be injured in fracture of be injured in fracture of surgical necksurgical neck. .

22-- The radial N. (which lies in the The radial N. (which lies in the spiral groove ) may be injured spiral groove ) may be injured in fracture of the middle of the in fracture of the middle of the shaftshaft. .

33-- The ulnar N. may be injured in The ulnar N. may be injured in fracture of the lower end fracture of the lower end (the medial epicondyle)(the medial epicondyle)

THE RADIUSTHE RADIUSIt is along bone , consist of thin narrow It is along bone , consist of thin narrow upper end ,body & thick expanded lower upper end ,body & thick expanded lower endend. .

The upper endThe upper end consist of consist of: :

11-- TheThe head head :is disc like with 2 articular :is disc like with 2 articular surfacessurfaces: :

1-11-1--the upper surface with the capitulum of the upper surface with the capitulum of the humerusthe humerus..

1-21-2--the lateral surface with the radial notch the lateral surface with the radial notch of the ulnaof the ulna . .

22--The The neckneck :constricted part below the head :constricted part below the head. .

33--The The radial tuberosityradial tuberosity :below the medial :below the medial part of the neckpart of the neck. .

THE RADIUSTHE RADIUS

The body of the radius which had The body of the radius which had 3 surfaces & 3 borders & 3 surfaces & 3 borders & pronator tuberositypronator tuberosity..

The lower end which is the styloid The lower end which is the styloid process laterally & ulnar notch process laterally & ulnar notch mediallymedially. .

THE RADIUSTHE RADIUSThe joints of the radiusThe joints of the radius: :

AboveAbove::1-1- the upper surface of the head the upper surface of the head receives the capitulum of the receives the capitulum of the humerus to form part of the humerus to form part of the elbowelbow

jointjoint . . 22-- the circumference of the head the circumference of the head

articulates with radial notch of the ulna to articulates with radial notch of the ulna to form the form the superiorsuperior radio-ulnar jointradio-ulnar joint. .

Below:Below: 1-1- the ulnar notch receives the head of the ulnar notch receives the head of the ulna to form the the ulna to form the inferior radio-ulnar jointinferior radio-ulnar joint. .

22-- the inferior surface of the lower end the inferior surface of the lower end articulate with 2 carpal bones to articulate with 2 carpal bones to form the form the wristwrist( radio-carpal )( radio-carpal )jointjoint

THE ULNATHE ULNA

It is along bone with upper end , body It is along bone with upper end , body (shaft ) & lower end(shaft ) & lower end..

The The upper endupper end consist of consist of: :

11-- The The olecranon processolecranon process :the upper :the upper part of the trochlear fossapart of the trochlear fossa. .

22-- The The coronoid processcoronoid process : the lower part : the lower part of the trochlear fossaof the trochlear fossa. .

33-- The The ulnar tuberosityulnar tuberosity :below the :below the coronoid process on the anterior coronoid process on the anterior surfacesurface. .

..

44--The The trochlear fossatrochlear fossa : is a large deeply : is a large deeply concave articular surface which concave articular surface which lies between the olecranon & lies between the olecranon &

coronoid processescoronoid processes . .

55-- The The radial notchradial notch is a concave surface is a concave surface in the upper part of the lateral in the upper part of the lateral side of the coronoid process. It side of the coronoid process. It articulates with the circumference articulates with the circumference of the head of the radius to form of the head of the radius to form the superior radio-ulnar jointthe superior radio-ulnar joint..

THE ULNATHE ULNA

THE ULNATHE ULNAThe bodyThe body (shaft) of the ulna is (shaft) of the ulna is triangular in the upper ¾ & triangular in the upper ¾ &

cylindrical in the lowercylindrical in the lower. ¼ . ¼

The lowerThe lower end consist of end consist of: :

11-- the the headhead : small rounded : small rounded articulating with the medial articulating with the medial side of the lower end of the side of the lower end of the radius forming the inferior radio – radius forming the inferior radio – ulnar jointulnar joint..

22 - -The The styloid processstyloid process : projects : projects medially & below the headmedially & below the head. .

The interosseous The interosseous membranemembrane: :

In addition to the sup. & inf. Radio ulnar In addition to the sup. & inf. Radio ulnar joints ,The radius & ulna are also joined by joints ,The radius & ulna are also joined by a fibrous membrane which stretches a fibrous membrane which stretches between the interosseous borders of the 2 between the interosseous borders of the 2 bonesbones....

It Ff. run obliquely downwards &medially It Ff. run obliquely downwards &medially from radius to ulnafrom radius to ulna..

It is pierced by the ant.interosseous VvIt is pierced by the ant.interosseous Vv..

Its function isIts function is

11-- increase the area of origin of forearm Mmincrease the area of origin of forearm Mm..

22 - -transmits forces received by the lower transmits forces received by the lower end of radius to ulnaend of radius to ulna..

The bones of the handThe bones of the handThey consist of :carpus , They consist of :carpus , metacarpus & phalanges metacarpus & phalanges bonesbones

The The carpuscarpus bones : they are 8 bones : they are 8 arrange in 2 rows ( proximal & distal arrange in 2 rows ( proximal & distal ))..

From lateral to medialFrom lateral to medial::

11-- the proximal row : the proximal row : scaphoid ,lunate , triquetral & scaphoid ,lunate , triquetral &

pisiformpisiform . .

22-- the distal row : trapezium , the distal row : trapezium , trapezoid , capitate & hamate trapezoid , capitate & hamate. .

The bones of the handThe bones of the handThe The MetacarpalMetacarpal bones : are 5 . One bones : are 5 . One for each fingerfor each finger. .

Each metacarpal bone has : Each metacarpal bone has : base ,shaft & headbase ,shaft & head. .

The The phalanges phalanges : all the fingers have : all the fingers have 3 phalanges ( proximal , middle & 3 phalanges ( proximal , middle & distal ) except the thumb has only distal ) except the thumb has only

2 (proximal & distal )2 (proximal & distal ) . .

Each phalanx has base , shaft & Each phalanx has base , shaft & headhead. .

The articulation of the carpal bonesThe articulation of the carpal bones

The proximal row is convex toward The proximal row is convex toward the lower end of radius & ulnathe lower end of radius & ulna. .

11-- The scaphoid & lunate articulate The scaphoid & lunate articulate with the lower end of the radiuswith the lower end of the radius. .

22 - -the triquetral articulates with the triquetral articulates with the lower end of the ulnathe lower end of the ulna. .

The bones of the proximal row The bones of the proximal row articulate with the bones of the articulate with the bones of the distal row in distal row in mid carpal mid carpal (transverese(transverese carpal) jointcarpal) joint..

The bones of the distal row The bones of the distal row articulate with the base of the articulate with the base of the metacarpals bymetacarpals by

11-- the trapezium articulate with the trapezium articulate with the 1the 1stst metacarpal bone metacarpal bone. .

22-- the trapazoid articulate with the the trapazoid articulate with the 22ndnd metacarpal metacarpal. .

33-- the capitate articulate with the the capitate articulate with the 33rdrd metacarpal metacarpal. .

44-- the hamate articulate with the the hamate articulate with the 44thth & 5 & 5thth metacarpals metacarpals....

THE MUSCLES OF THE UPPER THE MUSCLES OF THE UPPER LIMBLIMB

In general they divided toIn general they divided to

1-1- Mm attached the upper limb to Mm attached the upper limb to axial skeleton . axial skeleton .

2- 2- Mm of the upper limb proper .Mm of the upper limb proper .

Mm attached the upper Mm attached the upper limb to axial skeletonlimb to axial skeleton. .

1-11-1--THE FRONT MmTHE FRONT Mm..Pectoralis major , Pectoralis minor & Pectoralis major , Pectoralis minor & subclavius Mmsubclavius Mm..

1-21-2 - -AT SIDE MAT SIDE M. : serratus ant M. : serratus ant M..1-31-3 - -THE BACK MmTHE BACK Mm..

Latissmus dorsi , trapezius , levator Latissmus dorsi , trapezius , levator scapulae , rhomboideus minor & scapulae , rhomboideus minor & rhomboideus major Mmrhomboideus major Mm..

Only the pect. Major & latissmus dorsi are Only the pect. Major & latissmus dorsi are inserted in the humerus while all the inserted in the humerus while all the others are inserted in the shoulder others are inserted in the shoulder girdle( scapula & clavicle)girdle( scapula & clavicle). .

MOVEMENTS OF THE SHOULDER MOVEMENTS OF THE SHOULDER GIRDLEGIRDLE

11 - -ELEVATIONELEVATION: by upper Ff of trapezius & : by upper Ff of trapezius & levator scapulae Mmlevator scapulae Mm..

22--DEPRETIONDEPRETION: by pect.major , pect.minor : by pect.major , pect.minor &latissmus dorssi Mm&latissmus dorssi Mm..

33 - -RETRACTIONRETRACTION: by middle Ff. of trapezius, : by middle Ff. of trapezius, rhomboideus major & minor Mmrhomboideus major & minor Mm..

44 - -PROTRACTIONPROTRACTION: by serratus ant. ,levator : by serratus ant. ,levator scapulae & pect. Minorscapulae & pect. Minor..

55 - -ROTATION UPROTATION UP : by upper &lower Ff of : by upper &lower Ff of trapezius &serratus anterior Mmtrapezius &serratus anterior Mm..

66--ROTATION DOWNROTATION DOWN : levator : levator scapulae ,rhomboideus major & rhom. scapulae ,rhomboideus major & rhom. minor Mmminor Mm . .

MUSCLES OF THE SHOUlDER MUSCLES OF THE SHOUlDER REGIONREGIONThey are 6 Mm.: deltoid , teres major , They are 6 Mm.: deltoid , teres major , teres minor ,supraspinatusteres minor ,supraspinatus , , infraspinatus& subscabularis Mminfraspinatus& subscabularis Mm..

The last 4 called The last 4 called The Rotator cuff MmThe Rotator cuff Mm . .

All of them arise from the scapula ( all All of them arise from the scapula ( all from the dorsal surface except from the dorsal surface except subscapularis M. from the anterior subscapularis M. from the anterior surface ) & all inserted in the surface ) & all inserted in the tuberosities of humerus .They rotate the tuberosities of humerus .They rotate the arm(medially or laterally) & adduct the arm(medially or laterally) & adduct the arm (except the deltoid &supraspinatus arm (except the deltoid &supraspinatus Mm.) all suplied by C5, C6 NnMm.) all suplied by C5, C6 Nn..

MUSCLES OF THE FRONT OF MUSCLES OF THE FRONT OF THE ARMTHE ARM

They are :Biceps , Brachialis & coraco -They are :Biceps , Brachialis & coraco -brachialis Mm. and all supplied by musculo-brachialis Mm. and all supplied by musculo-cutaneous Ncutaneous N..

The biceps The biceps act on the shoulder jt. as put the act on the shoulder jt. as put the head of humerus in its place & on elbow jt. head of humerus in its place & on elbow jt. as flexor &supinator as it inserted in the as flexor &supinator as it inserted in the post. part of tuberosity of the radiuspost. part of tuberosity of the radius..

The brachialisThe brachialis M. from the shaft of humerus M. from the shaft of humerus to the tuberosity of ulna, act as flexor to to the tuberosity of ulna, act as flexor to the elbowthe elbow..

The coracobrachialisThe coracobrachialis act as flexor & adductor act as flexor & adductor to the armto the arm..

MUSCLES OF THE BACK OF THE MUSCLES OF THE BACK OF THE ARMARM:.:.

It is the It is the Triceps M.:Triceps M.: the long ,medial the long ,medial & lateral heads inserted in the & lateral heads inserted in the upper post. Part of olecranon upper post. Part of olecranon process& supplied by the radial N. process& supplied by the radial N. to act as extensor of the elbow & to act as extensor of the elbow & stabilize the elbow jtstabilize the elbow jt..

THE FOREARM MUSCLESTHE FOREARM MUSCLES They divided to 2 groupsThey divided to 2 groups : :

11-- The flexor- pronator gpThe flexor- pronator gp..22 - -The extensor- supinator gpThe extensor- supinator gp..

THE FLEXOR –PRONATOR GROUPTHE FLEXOR –PRONATOR GROUP: : * * They flex the wrist ,fingers & pronate the They flex the wrist ,fingers & pronate the

forearmforearm..* * They divided to superficial & deep groupsThey divided to superficial & deep groups..

* * The The superficial groupsuperficial group arise from the front arise from the front of medial epicondyle of humerus, pass of medial epicondyle of humerus, pass in front of the forearm& the wrist to in front of the forearm& the wrist to

inserted in bones of the handinserted in bones of the hand . .

THE FLEXOR –PRONATOR THE FLEXOR –PRONATOR GROUPGROUP: :

They are :Pronator teres , Fl. Carpi-They are :Pronator teres , Fl. Carpi-radialis , Fl. Carpi-ulnaris ,Fl. radialis , Fl. Carpi-ulnaris ,Fl. Digitorum superficialis &palmaris Digitorum superficialis &palmaris longus Mmlongus Mm. .

The The deep groupdeep group arise from the front of arise from the front of interosseous membrane & radius & interosseous membrane & radius & ulnaulna..

They are : Fl.digitorum profundus , They are : Fl.digitorum profundus , Fl.pollicis longus & pronator quadratus Fl.pollicis longus & pronator quadratus MmMm..

THE FLEXOR –PRONATOR THE FLEXOR –PRONATOR GROUPGROUP: :

The pronatorsThe pronators are Pronator teres & Pronator are Pronator teres & Pronator quadratus Mm. where inserted in the quadratus Mm. where inserted in the radius & pronate the forearm radius & pronate the forearm. .

The flexors of the wristThe flexors of the wrist are Fl.carpi- are Fl.carpi-radialis ,Fl. carpi-ulnaris & Palmaris longus radialis ,Fl. carpi-ulnaris & Palmaris longus where inserted in the metacarpal where inserted in the metacarpal bonesbones. .

The flexor of the fingersThe flexor of the fingers are Fl. digitorum are Fl. digitorum superficialis & Fl. Digitorum profundus superficialis & Fl. Digitorum profundus

where inserted in the phalanges where inserted in the phalanges . .The flexor of the thumbThe flexor of the thumb is Fl. Pollicis longus& is Fl. Pollicis longus& inserted in phalanges of the thumbinserted in phalanges of the thumb. .

THE EXTENSOR - SUPINATOR THE EXTENSOR - SUPINATOR GROUPGROUP..

**They extend the wrist & the fingers & They extend the wrist & the fingers & supinate the forearm supinate the forearm. .

* * They divided to They divided to superficial & deep groupssuperficial & deep groups::

The superficial groupThe superficial group arise from the back of arise from the back of the lateral epicondyle of humerus to pass the lateral epicondyle of humerus to pass on the back of the forearm & inserted in on the back of the forearm & inserted in the bones of the hand . The arethe bones of the hand . The are 7 7 ; ; Brachio-radialis , extensor carpi – radialis Brachio-radialis , extensor carpi – radialis longus ;ext.calpi-radialis longus ;ext.calpi-radialis brevis ;ext.digitorum ; ext. digiti- brevis ;ext.digitorum ; ext. digiti- minimi ;ext. carpi –ulnaris & anconeus Mmminimi ;ext. carpi –ulnaris & anconeus Mm..


The deep groupThe deep group is is 55 Mm : Mm : supinator ;abductor pollicis supinator ;abductor pollicis longus ; ext. pollicis brevis ; ext. longus ; ext. pollicis brevis ; ext. pollicis longus & ext. indicis Mmpollicis longus & ext. indicis Mm . .


The supinatorsThe supinators are :Supinator ,Brachio are :Supinator ,Brachio radialis & the anconeus Mm. where radialis & the anconeus Mm. where inserted in the bones of the forearminserted in the bones of the forearm..The extensor of the wristThe extensor of the wrist are : Ext.carpi- are : Ext.carpi-radialis longus , Ext. carpi-radialis brevis radialis longus , Ext. carpi-radialis brevis & ext. carpi-ulnaris Mm. where inserted & ext. carpi-ulnaris Mm. where inserted in the metacarpal bones& extend the in the metacarpal bones& extend the wristwrist . .

The extensors of the fingersThe extensors of the fingers are :Ext. are :Ext. digitorum ; Ext. digiti- minimi & Ext. digitorum ; Ext. digiti- minimi & Ext. indicis where inserted in the fingers & indicis where inserted in the fingers & extend the metacarpo-phalangeal extend the metacarpo-phalangeal jointsjoints. .


The muscles of the thumbThe muscles of the thumb are : are : Abductor pollicis longus , Ext. Abductor pollicis longus , Ext. pollicis brevis & ext. pollicis pollicis brevis & ext. pollicis longus Mm. where inserted in longus Mm. where inserted in the thumb bonesthe thumb bones. .

THE FLEXOR RETINACULUMTHE FLEXOR RETINACULUMIt is a thick band made of dense white It is a thick band made of dense white fibrous tissue which stretch across the fibrous tissue which stretch across the anterior surface of the carpus bones anterior surface of the carpus bones which are concave in shape ( carpus which are concave in shape ( carpus arch ) changing the arch to carpus tunnelarch ) changing the arch to carpus tunnel ..

In the tunnel pass the median nerve & In the tunnel pass the median nerve & tendons of Mmtendons of Mm..

THE EXTENSOR RETINACULUMTHE EXTENSOR RETINACULUMIt is a thickening of deep fascia between It is a thickening of deep fascia between the lower ends of radius & ulnathe lower ends of radius & ulna. .

THE MUSCLES OF THE HANDTHE MUSCLES OF THE HANDThey divided to thenar & hypothenar MmThey divided to thenar & hypothenar Mm . .

The thenar MmThe thenar Mm: Abductor pollicis brevis , : Abductor pollicis brevis , flexor pollicis brevis & opponens pollicis flexor pollicis brevis & opponens pollicis MmMm..

The hypothenar MmThe hypothenar Mm : abductor digiti : abductor digiti minimi ,flexor digiti minimi & opponens minimi ,flexor digiti minimi & opponens digiti minimi Mmdigiti minimi Mm..

There are also There are also 44 lumbrical Mmlumbrical Mm & & 77 InterosseousInterosseous MmMm. in the fingers. in the fingers. .

All these Mm responsible for fine All these Mm responsible for fine movements of fingersmovements of fingers..

IMPOTANT REGIONS IN IMPOTANT REGIONS IN THE UPPER LIMBTHE UPPER LIMB

THE BREASTTHE BREASTTHE AXILLATHE AXILLA

THE BREAST( THE MAMMARY THE BREAST( THE MAMMARY GLAND)GLAND): :

It lies in the superficial fascia . It is It lies in the superficial fascia . It is modified skin gland & rudimentary in modified skin gland & rudimentary in males .In female , the non-lactating males .In female , the non-lactating mammary gland is formed of fat & milk mammary gland is formed of fat & milk glands& covered by a skin contain the glands& covered by a skin contain the nipple & the areolanipple & the areola..It extends from the 2It extends from the 2ndnd rib to 6 rib to 6thth rib & rib & from the edge of sternum to the mid-from the edge of sternum to the mid-axillary lineaxillary line..Each gland is formed of 16-20 lobes & Each gland is formed of 16-20 lobes & each lobe divided to lobuleseach lobe divided to lobules..

THE BREAST( THE MAMMARY THE BREAST( THE MAMMARY GLAND)GLAND): :

The lymphatic drainage of the The lymphatic drainage of the lateral side of the breast go to lateral side of the breast go to axillary L.N. while the medial axillary L.N. while the medial side of the breast go to the side of the breast go to the internal mammary chain of L.Ninternal mammary chain of L.N..

It is the pathway of breast cancer It is the pathway of breast cancer to matestasize in the bodyto matestasize in the body. .

THE LYMPH NODES OF THE THE LYMPH NODES OF THE AXILLAAXILLA

They divided toThey divided to: :

11 - -The The anterioranterior ( pectoral) group ( pectoral) group. .

22 - -The The posteriorposterior (subscapular ) (subscapular ) groupgroup..

33 - -The The laterallateral group: along the group: along the axillary veinaxillary vein

44 - -The The centralcentral group : in the base of group : in the base of the axillathe axilla. .

55 - -The The apicalapical group :in the apex of group :in the apex of the axillathe axilla . .

ARTERIES OF THE UPPER ARTERIES OF THE UPPER LIMBLIMB::

THE AXILLARY ARTERYTHE AXILLARY ARTERY :It begins :It begins at the outer border of the 1at the outer border of the 1stst rib rib as a continuation of the as a continuation of the Subclavian A. & ends at the Subclavian A. & ends at the lower border of the teres major lower border of the teres major M. by becoming the M. by becoming the Brachial ABrachial A..

The pctoralis minor M . divided it The pctoralis minor M . divided it to 3 partsto 3 parts::

ARTERIES OF THE UPPER LIMBARTERIES OF THE UPPER LIMB::The 1The 1stst part part : lies above the pectoralis : lies above the pectoralis minor & give one branch (superior minor & give one branch (superior thoracic A.) . It lies very deeply with thoracic A.) . It lies very deeply with the axillary vein on its medial sidethe axillary vein on its medial side. .

The 2The 2ndnd part part : lies behind the pectoralis : lies behind the pectoralis minor M. & gives 2 branches ( acromio minor M. & gives 2 branches ( acromio -thoracic A.& lateral thoracic A. )-thoracic A.& lateral thoracic A. )..The 3The 3rdrd part part : lies below the pectoralis : lies below the pectoralis minor M. & gives 3 branches :minor M. & gives 3 branches :( subscapular A., post. circumflex ( subscapular A., post. circumflex humeral A. & ant . Circumflex humeral humeral A. & ant . Circumflex humeral A.)A.) . .


It is an important anastamosis between It is an important anastamosis between branches of the first part of the branches of the first part of the subclavian A.& the third part of axillary Asubclavian A.& the third part of axillary A..

11 - -branches of the first part of the branches of the first part of the subclavian Asubclavian A

1-11-1 - -the supra scapularthe supra scapular A. which distributed A. which distributed to the supraspinous & the infraspinous to the supraspinous & the infraspinous fossafossa..

1-21-2 - -deep branch of the transverse cervical deep branch of the transverse cervical AA. which go down along the medial . which go down along the medial border of the scapulaborder of the scapula..


22 - -The branches of the third part of The branches of the third part of axillary Aaxillary A..

2-12-1 - -the sub scapular Athe sub scapular A. which go down . which go down along the lateral border of the scapulaalong the lateral border of the scapula..

2-22-2 - -the circumflex scapularthe circumflex scapular AA. which arise . which arise from the sub scapular A.& go to the from the sub scapular A.& go to the infraspinous fossainfraspinous fossa..

ARTERIES OF THE UPPER ARTERIES OF THE UPPER LIMBLIMB::THE BRACHIAL ARTERYTHE BRACHIAL ARTERY: :

It begins at the lower border of the It begins at the lower border of the Teres major M. as a continuation of Teres major M. as a continuation of the Axillary A. & ends at the level of the Axillary A. & ends at the level of the neck of the Radius by dividing to the neck of the Radius by dividing to Radial & Ulnar AaRadial & Ulnar Aa..It is a superficial A. lies immediately It is a superficial A. lies immediately below the deep fasciabelow the deep fascia..The basilic vein lies on its medial sideThe basilic vein lies on its medial side..In the upper part , the brachial A. lies to In the upper part , the brachial A. lies to the medial side of the humerus while the medial side of the humerus while in the lower part lies anterior to itin the lower part lies anterior to it..

THE BRACHIAL ARTERYTHE BRACHIAL ARTERY: :

The branches of the brachial A.: It The branches of the brachial A.: It supplies all the Mm. of the arm & supplies all the Mm. of the arm & gives 3 branchesgives 3 branches

11 - -the profunda brachii Athe profunda brachii A..

22 - -the superior ulnar collateral Athe superior ulnar collateral A . .

33 - -the inferior ulnar collateral Athe inferior ulnar collateral A..

The profunda brachii AThe profunda brachii A. is the largest . is the largest branch & pass with the radial N. in branch & pass with the radial N. in the spiral groove of the humerus to the spiral groove of the humerus to end in 2 terminal branches above the end in 2 terminal branches above the elbow jointelbow joint. .

Anastamosis around The Elbow Anastamosis around The Elbow JointJoint: : It is a rich anastamosis between small It is a rich anastamosis between small branches of brachial ,ulnar & radial Aabranches of brachial ,ulnar & radial Aa:.:.

11 - -anastamosis around medial epicondyleanastamosis around medial epicondyle : :

The two branches of the brachial A .(the The two branches of the brachial A .(the superior ulnar collateral A. & the inferior superior ulnar collateral A. & the inferior ulnar collateral A.) with the branches of ulnar collateral A.) with the branches of ulnar A. (the ant. & post. Ulnar recurrent ulnar A. (the ant. & post. Ulnar recurrent Aa.) .i.e. the brachial & the ulnar Aa. Aa.) .i.e. the brachial & the ulnar Aa. onlyonly. .

22 - -anastamosis around lateral epicondyleanastamosis around lateral epicondyle: :

The 2 terminal branches of the profuda The 2 terminal branches of the profuda brachii a. with recurrent branches of brachii a. with recurrent branches of

ulnar & radial Aaulnar & radial Aa..

THE RADIAL ARTERYTHE RADIAL ARTERY::It begins in the cubital fossa at the level It begins in the cubital fossa at the level opposite to the neck of the radius & opposite to the neck of the radius & ends in the palm by becoming the ends in the palm by becoming the deep palmerdeep palmer archarch. .

It is the smaller of the 2 terminal It is the smaller of the 2 terminal branches of the brachial artery & branches of the brachial artery & descend in the lateral part of the front descend in the lateral part of the front of the forearmof the forearm. .

At the lower end of the radius , it leaves At the lower end of the radius , it leaves the front of the forearm & turns the front of the forearm & turns backward round the lateral border of backward round the lateral border of the wrist , below the styloid process of the wrist , below the styloid process of the radius& enter the anatomical the radius& enter the anatomical snuff-box where the pulsation can be snuff-box where the pulsation can be felt then pass to the palmfelt then pass to the palm. .

THE RADIAL ARTERYTHE RADIAL ARTERY::It is deep in the upper part of the It is deep in the upper part of the forearm to become superficial in the forearm to become superficial in the lower part of the forearm where we lower part of the forearm where we can feel the radial pulsecan feel the radial pulse..

The radial N . runs along the lateral The radial N . runs along the lateral side of the A. in the middle 1/3 then side of the A. in the middle 1/3 then leave it in the lower 1/3 to go leave it in the lower 1/3 to go backwardbackward. .

the radial A. form the deep palmer the radial A. form the deep palmer arch of the hand after giving many arch of the hand after giving many branches in the forearm & the handbranches in the forearm & the hand. .

THE ULNAR ARTERYTHE ULNAR ARTERY: : It begins in the cubital fossa at the level It begins in the cubital fossa at the level opposite to the neck of the radius & opposite to the neck of the radius & ends in the palm by becoming ends in the palm by becoming thetheSUPERFICIAL PALMER ARCHSUPERFICIAL PALMER ARCH..It is the larger branch of the brachial A. It is the larger branch of the brachial A. It runs obliquely-medially in the upper It runs obliquely-medially in the upper part & vertically in the lower part of part & vertically in the lower part of the forearm where be superficial & the forearm where be superficial & gives the deep palmer branch ( which gives the deep palmer branch ( which helps in forming the deep palmer helps in forming the deep palmer arch ) then becomes the superficial arch ) then becomes the superficial palmer archpalmer arch..

THE ULNAR ARTERYTHE ULNAR ARTERY: : The The ulnar Nulnar N. runs on medial side of . runs on medial side of the lower 2/3 of the ulnar artery the lower 2/3 of the ulnar artery while the while the median N.median N. lies in the lies in the medial side of the A. in the medial side of the A. in the cubital fossa then pass the A. cubital fossa then pass the A. obliquely to be in the middle part obliquely to be in the middle part of the lower 2/3 of the forearmof the lower 2/3 of the forearm..It gives the ant. & post. Ulnar It gives the ant. & post. Ulnar recurrent Aa which form recurrent Aa which form anastamosis with the brachial A. anastamosis with the brachial A. in the elbow region. Also gives in the elbow region. Also gives many branches in the forearm many branches in the forearm &above the wrist&above the wrist..

THE SUPERFICIAL THE SUPERFICIAL PALMER ARCHPALMER ARCH: :

It is superficial because It is superficial because it lies immediately it lies immediately next to the palmer next to the palmer aponeurosisaponeurosis . .

It is formed mainly by It is formed mainly by the ulnar A. with the the ulnar A. with the superficial palmer superficial palmer branch of the radial branch of the radial AA..It gives 4 digital Aa. to It gives 4 digital Aa. to supply the 4 medial supply the 4 medial fingersfingers..

THE DEEP PALMER ARCHTHE DEEP PALMER ARCH: :

It is formed mainly It is formed mainly by the radial A. by the radial A. with the deep with the deep palmer branch of palmer branch of the ulnar Athe ulnar A . .

It gives 3 palmer – It gives 3 palmer – metacarpal Aa. To metacarpal Aa. To pass to the clefts of pass to the clefts of the fingersthe fingers..

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUSA plexus: it is a complex arrangement of A plexus: it is a complex arrangement of the anterior primary rami of certain the anterior primary rami of certain spinal Nn. Which gives branches to spinal Nn. Which gives branches to supply the Mm. & skin of a certain part supply the Mm. & skin of a certain part of a bodyof a body..

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUS

It is formed by the anterior primary rami It is formed by the anterior primary rami of of C5,C6,C7,C8 &T1C5,C6,C7,C8 &T1 Nn. these are Nn. these are called called ROOTSROOTS of the plexus of the plexus..

It lies in the lower part of the neck It lies in the lower part of the neck behind the clavicle & in the axilla & behind the clavicle & in the axilla & formed of 4 main parts : formed of 4 main parts : Roots , Trunks Roots , Trunks , Divisions &, Divisions & cordscords..

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUS11 - -The rootsThe roots: lie in the neck between the : lie in the neck between the

scaleneus ant. & scaleneus medius Mmscaleneus ant. & scaleneus medius Mm..

22 - -The The trunkstrunks : traverse the lower part of : traverse the lower part of the posterior triangle of the neck the posterior triangle of the neck. .

33 - -The The divisionsdivisions : lie behind the middle 1/3 : lie behind the middle 1/3 of the clavicle of the clavicle . .

44 - -The The cordscords : lie in the axilla : lie in the axilla. .

THE TRUNKSTHE TRUNKS formed by formed by: :

The roots of C5 & C6 unite to form the The roots of C5 & C6 unite to form the upper trunkupper trunk

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUSThe root of C7 alone form the The root of C7 alone form the middle middle trunktrunk..

The roots of C8 & T1 unite to form the The roots of C8 & T1 unite to form the lower trunklower trunk..

Then each trunk divides into Then each trunk divides into anterior &anterior & posterior divisionposterior division. .

Then the 3 posterior divisions unite to Then the 3 posterior divisions unite to form form the posterior cordthe posterior cord. .

The anterior divisions of the upper & The anterior divisions of the upper & middle trunks form the middle trunks form the lateral cordlateral cord . .

The anterior division of the lower trunk The anterior division of the lower trunk alone forms the alone forms the medial cordmedial cord. .

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUSSo we have ; 5 roots , 3 trunks , 6 So we have ; 5 roots , 3 trunks , 6 divisions , 3 cords & 5 terminal divisions , 3 cords & 5 terminal branchesbranches. .

No branches arise from the trunks nor No branches arise from the trunks nor from the divisions ( except the from the divisions ( except the suprascapular N. which come from the suprascapular N. which come from the erbs point=at beginning of the upper erbs point=at beginning of the upper

trunk)trunk). .. .

The brachial plexus gives The brachial plexus gives 1616 branches , branches , 1111 small branches & small branches & 55 big branches : big branches : radial , ulnar , median , circumflex radial , ulnar , median , circumflex (axillary) & musclocutaneous Nn(axillary) & musclocutaneous Nn..


THE BRANCHES OF THE CORDSTHE BRANCHES OF THE CORDS::

They are 2 types :main branches & small They are 2 types :main branches & small branchesbranches..

Each cord gives Each cord gives 2 main branches2 main branches: :

11-- the posterior cord: radial n & the posterior cord: radial n & circumflex N (axillary N.)circumflex N (axillary N.)..

22-- the medial cord : ulnar N. & medial the medial cord : ulnar N. & medial root of median nroot of median n . .

33-- the lateral cord : the lateral root of the lateral cord : the lateral root of median N. & musclocutaeous Nmedian N. & musclocutaeous N..

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUSThe The small branchessmall branches of the cords are of the cords are: :

11-- from the posterior cord :upper from the posterior cord :upper subscapular Nsubscapular N..

N. To latissmus dorsi N. To latissmus dorsi =(thoracodorsal N.) =(thoracodorsal N.)..

Lower subscapular NLower subscapular N . .22-- from the lateral cord : lateral pectoral Nfrom the lateral cord : lateral pectoral N..33-- from the medial cord : medial pectoral Nfrom the medial cord : medial pectoral N..

Medial cutaneous N. of the Medial cutaneous N. of the arm Medial cutaneous N. arm Medial cutaneous N. of the forearmof the forearm . .

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUSTHE BRANCHES OF THE ROOTSTHE BRANCHES OF THE ROOTS::

There are 4 branchesThere are 4 branches: :

11-- from C5 :N. to rhemboids Mm.from C5 :N. to rhemboids Mm.(rh.major ,rh. Minor & levator (rh.major ,rh. Minor & levator scapulae)scapulae)

22-- from C5,C6,C7 :N. to serratus anterior from C5,C6,C7 :N. to serratus anterior (long thoracic N.) (long thoracic N.)..

33-- from C6 : N. to subclaviusfrom C6 : N. to subclavius..

44-- at the union of C5 & C6 (erbs point): at the union of C5 & C6 (erbs point): suprascapular N.( to suprascapular N.( to supraspinatus & infraspinatus)supraspinatus & infraspinatus)..

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUSEach cord gives rise to 2 branches one is big Each cord gives rise to 2 branches one is big & consider the continuation of the cord & & consider the continuation of the cord & one is small SOone is small SO The posterior cord continues as the radial NThe posterior cord continues as the radial N . .The medial cord continues as the ulnar NThe medial cord continues as the ulnar N..The lateral cord continues as the median NThe lateral cord continues as the median N..The 3 cords named according to their The 3 cords named according to their position to 2position to 2ndnd part of the axillary A. (post. , part of the axillary A. (post. , medial & lateral.) while the name of the medial & lateral.) while the name of the main N. according to position in the main N. according to position in the forearm( ulnar , median & radial )forearm( ulnar , median & radial )..

THE BRACHIAL PLEXUSTHE BRACHIAL PLEXUSThe The 5 main Nn5 main Nn. Arise opposite the lower . Arise opposite the lower border of the pectoralis minor M. near border of the pectoralis minor M. near the coracoid processthe coracoid process. .

11-- The circumflex (axillary ) N. supplies the The circumflex (axillary ) N. supplies the deltoid & teres minor Mm. then deltoid & teres minor Mm. then become the lateral cutaneousN. of become the lateral cutaneousN. of

the armthe arm . .22-- The musculocutaneous N. supplies the The musculocutaneous N. supplies the

biceps , coracobrachialis & biceps , coracobrachialis & brachialis Mm. then become the brachialis Mm. then become the lateral cutaneous N. of the forearmlateral cutaneous N. of the forearm . .

33-- The median N ( with its branch =ant. The median N ( with its branch =ant. Interosseous N.) supplies most of Interosseous N.) supplies most of the Mm. of front of the the Mm. of front of the forearm with sensation of forearm with sensation of lateral 3 & ½ fingers lateral 3 & ½ fingers

anteriorlyanteriorly . .


44-- The radial N.( with its The radial N.( with its branch=post. Interosseous branch=post. Interosseous N.) supplies most of the mm. N.) supplies most of the mm. of the back of the forearm. of the back of the forearm. With sensation of lateral 3 & ½ With sensation of lateral 3 & ½

fingers posteriorly fingers posteriorly . .

55-- The ulnar N. supplies Mm. on the The ulnar N. supplies Mm. on the medial side of the forearm medial side of the forearm with sensation of medial 1 with sensation of medial 1 & ½ fingers anteriorly & & ½ fingers anteriorly &

posteriorlyposteriorly . .

THE DERMATOMES OF THE THE DERMATOMES OF THE UPPER LIMBUPPER LIMB

It is the cutaneous sensation of the upper limbIt is the cutaneous sensation of the upper limb..

C4C4 supplies the skin over the tip of the supplies the skin over the tip of the shouldershoulder. .

C5C5 supplies the lateral side of the arm &the supplies the lateral side of the arm &the upper lateral part of the forearm upper lateral part of the forearm . .

C6 C6 supplies the lateral side of the lower part of supplies the lateral side of the lower part of the forearm & the lateral aspect of the the forearm & the lateral aspect of the handhand

C7C7 supplies the middle aspect of the hand supplies the middle aspect of the hand (ant.& post.)(ant.& post.) . .

THE DERMATOMES OF THE THE DERMATOMES OF THE UPPER LIMBUPPER LIMBC8C8 supplies the medial side of the supplies the medial side of the hand & the medial lower part of hand & the medial lower part of the forearmthe forearm..

T1T1 supplies the medial part of the supplies the medial part of the upper part of the forearm & the upper part of the forearm & the

medial lower part of the armmedial lower part of the arm . .

T2T2 supplies the medial side of the supplies the medial side of the upper part of the arm & the upper part of the arm & the floor of the axillafloor of the axilla . .

THE VEINS OF THE UPPER THE VEINS OF THE UPPER LIMBLIMBThere are superficial & deep veins in There are superficial & deep veins in the upper limbthe upper limb. .

11--the deep veinsthe deep veins are the veins are the veins which accompany the main Aa. ( way which accompany the main Aa. ( way & name )& name )..

22 - -The superficial Vv.The superficial Vv. : start as : start as superficial venous network on the superficial venous network on the back of the hand. this network drains back of the hand. this network drains in 2 directions ;laterally into Cephalic in 2 directions ;laterally into Cephalic V & medially to the basilic VV & medially to the basilic V..

THE VEINS OF THE UPPER THE VEINS OF THE UPPER LIMBLIMB

THE CEPHALIC VEINTHE CEPHALIC VEIN: :

It starts in the superficial fascia just It starts in the superficial fascia just behind the styloid process of the behind the styloid process of the radius . Then it runs upward to the radius . Then it runs upward to the anterior surface of the forearm ; in the anterior surface of the forearm ; in the upper arm it lies in a groove along the upper arm it lies in a groove along the lateral border of biceps M. then lateral border of biceps M. then pierces the deep fascia in a groove pierces the deep fascia in a groove between the deltoid & pectoralis major between the deltoid & pectoralis major Mm. to inter the axillary veinMm. to inter the axillary vein..

THE VEINS OF THE UPPER LIMBTHE VEINS OF THE UPPER LIMBTHE BASILIC VEINTHE BASILIC VEIN::

It ascends along the postero-medial It ascends along the postero-medial surface of the forearm; to go in the surface of the forearm; to go in the ant. surface just below the Elbow. It ant. surface just below the Elbow. It pierces the deep fascia in the middle pierces the deep fascia in the middle of the arm .At the edge of the post. of the arm .At the edge of the post. fold of the axilla its joined by the fold of the axilla its joined by the brachial Vv. to form the brachial Vv. to form the Axillary veinAxillary vein..

THE VEINS OF THE UPPER LIMBTHE VEINS OF THE UPPER LIMB

THE MEDIAN CUBITAL VEINTHE MEDIAN CUBITAL VEIN: :

It is the most prominent superficial It is the most prominent superficial vein in the bodyvein in the body. .

It joins the cephalic & the basilic Vv It joins the cephalic & the basilic Vv just distal to the front of the elbow just distal to the front of the elbow jointjoint..

These superficial veins are more These superficial veins are more important than the deep Vv. Because important than the deep Vv. Because they are larger in size & used for they are larger in size & used for intravenous injectionsintravenous injections..

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ANATOMY OF THE UPPER LIMB DR.AHMAD K. SHAHWAN PH.D. GENERAL SURGERY DR.AHMAD K. SHAHWAN PH.D. GENERAL SURGERY